Pressure-lowering Medications Research Articles

The Relationship of Mean Deviation Scores and Resource Utilization Among Patients With Glaucoma

To determine the relationship between mean deviation (MD) scores and resource utilization among glaucoma patients in the United States and Europe. A retrospective analysis of patient in the United States (June 1990 to January 2003, N=151) and Europe (June 1994 to July 2003, N=194) was conducted. Office visits, pressure-lowering medications, visual field examinations, and glaucoma surgeries were recorded with age, intraocular pressure (IOP), and MD. Patients with missing MD and IOP were excluded; final sample sizes were 130 in the United States and 161 in Europe. Fixed effects and logistic regression models assessed the associations between MD and visits, medication, examinations, and surgery. Number of office visits and visual field examinations significantly increased but the number of glaucoma medications decreased as MD worsened and IOP increased. Odds of trabeculoplasty within 2 years decreased by 8.1% in the United States and 9.9% in Europe with every 1.0 dB improvement in MD. Odds of trabeculectomy within 2 years increased by 13.9% in the United States and by 18.6% in Europe with every 1 mm Hg increase in IOP. In the United States, odds of trabeculectomy within 5 years increased by 12.2% with each 1.0 dB worsening in MD. MD is associated with resource utilization in glaucoma patients. Evidence supporting use of MD to predict surgery is less conclusive, possibly due to the relative low frequency of surgeries. Therapies aimed at stabilizing visual field deterioration may reduce resource use and costs associated with glaucoma; however, more research is necessary to establish whether such treatments meet common standards of cost-effectiveness.

Anti-hypertensive Nutraceuticals and Functional Foods

Epidemiological studies have demonstrated that elevated blood pressure is one of the major risk factors for stroke and coronary heart disease (CHD). A close association between blood pressure and the incidence of cardiovascular diseases is well established if systolic/diastolic blood pressure is above 140/90 mmHg. In recent years, nutraceuticals and functional foods have attracted considerable interest as potential alternative therapies for treatment of hypertension, especially for prehypertensive patients, whose blood pressure is marginally or mildly high but not high enough to warrant the prescription of blood pressure-lowering medications. This review summarizes the findings of recent studies on the chemistry, production, application, efficacy, and mechanisms of popular blood pressure-lowering nutraceuticals and functional foods including the Dietary Approaches to Stop Hypertension (DASH) diet plan, L-arginine, chlorogenic acid, fermented milk, garlic, onion, tea, soybean, ginger, hawthorn, and fish oil.

Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India

The rate of cardiovascular disease is widely considered to be increasing throughout India. Precise and reliable data on fatal and nonfatal cardiovascular disease, however, are few, and little is known about the use of preventive therapies. This is particularly true for rural regions. Data were collected from 53 villages in the Godavari region of Andhra Pradesh. Mortality data were obtained from a verbal autopsy-based mortality surveillance system during a 12-month period in 2003 to 2004. The prevalence of nonfatal cardiovascular disease and the use of preventive therapies were estimated from a stratified random sample of 4535 adults (> or =30 years of age) in 2005. Cardiovascular disease was the leading cause of mortality, accounting for at least 32% of all deaths. The average age at cardiovascular death was 65 years, and 51% of all cardiovascular deaths occurred in patients <70 years of age. Among adults, the prevalence of coronary heart disease was estimated to be 4.8% (95% CI, 4.1 to 5.5), and the prevalence of cerebrovascular disease was estimated at 2.0% (95% CI, 1.5 to 2.4). Among individuals with either diagnosis, 14% (95% CI, 10 to 18) reported taking aspirin, 41% (95% CI, 36 to 47) took a blood pressure-lowering medication, and 5% (95% CI, 3 to 7) reported using a cholesterol-lowering medication. This region has a large disease burden attributable to cardiovascular disease with significant underuse of proven, low-cost preventive medications.

Health consequences of aircraft noise.

The ever-increasing level of air traffic means that any medical evaluation of its effects must be based on recent data. Selective literature review of epidemiological studies from 2000 to 2007 regarding the illnesses, annoyance, and learning disorders resulting from aircraft noise. In residential areas, outdoor aircraft noise-induced equivalent noise levels of 60 dB(A) in the daytime and 45 dB(A) at night are associated with an increased incidence of hypertension. There is a dose-response relationship between aircraft noise and the occurrence of arterial hypertension. The prescription frequency of blood pressure-lowering medications is associated dose-dependently with aircraft noise from a level of about 45 dB(A). Around 25% of the population are greatly annoyed by exposure to noise of 55 dB(A) during the daytime. Exposure to 50 dB(A) in the daytime (outside) is associated with relevant learning difficulties in schoolchildren. Based on recent epidemiological studies, outdoor noise limits of 60 dB(A) in the daytime and 50 dB(A) at night can be recommended on grounds of health protection. Hence, maximum values of 55 dB(A) for the day and 45 dB(A) for the night should be aimed for in order to protect the more sensitive segments of the population such as children, the elderly, and the chronically ill. These values are 5 to 10 dB(A) lower than those specified by the German federal law on aircraft noise and in the report "synopsis" commissioned by the company that runs Frankfurt airport (Fraport).

Can Adherence to Topical Glaucoma Medication be Improved by Using an Audible Alarm?

Background Adherence to long-term intraocular pressure (IOP) lowering medication is poor in patients with glaucoma, which is a significant factor in disease progression. Aim To investigate whether objectively monitored adherence to 0.004% travoprost (Travatan®), an IOP-lowering prostaglandin-analogue eye drop, improves if the audible alarm function of the monitoring device is activated. Methods Thirty-nine consecutive patients already on self-administered once-daily (evening) travoprost medication for glaucoma received an electronic monitoring device on loan and detailed training on its use. An adherent day was defined as a day with instillation of travoprost (from the monitoring device) at 9:00 pm ± 2 hours. In the first 3-month phase of the investigation, the audible alarm function of the device was disabled, but in the second 3-month period it was activated and set for 9:00 pm. The participants continued using their other eye drops in both phases of the study. Results Thirty-four participants completed both periods. Non-adherence (mean ± SD) was 18.4 ± 18.9% in the first period and 14.7 ± 18.9% during the second (Wilcoxon signed rank test, p = 0.059). Thus, adherence was 81.6% with the alarm function disabled, and 85.3% when the signal was activated. A significant positive correlation was found between the number of daily eye drop instillations and change of non-adherence (Spearman’s correlation, p = 0.014), showing that when more instillations were used, less marked adherence-improvement was achieved. Conclusion Though adherence to once-daily topical travoprost medication was satisfactorily high even without the audible alarm function being activated, a nonsignificant tendency for a further improvement of adherence was found when the audible signal was present. For patients who instilled eye drops more frequently, this improvement was significantly less. Our results suggest that using an audible alarm signal set for the time of instillation may have a role in improving adherence in patients with glaucoma who already have relatively good adherence to their medication regimen; however, further studies are required to test this hypothesis.

Pathogenesis of Elevated Peripheral Pulse Pressure

“Ashes to ashes, dust to dust, if the cancer don’t get us, the arteriosclerosis must” — —Richard Gordon in The Alarming History of Medicine, 1993 Substantial evidence suggests that arterial remodeling evolves over a life course under the conjoint influence of genes, environmental factors (including vascular risk factors), and lifestyle characteristics (such as diet and physical activity).1 Such arterial remodeling involves multiple vascular territories and is panarterial, ie, it involves all layers of the arterial wall.1 More recently, considerable attention has focused on the physiological aspects of propagation of blood within the aorta, and several important concepts have evolved. First, the aorta is no longer regarded as just a passive conduit that transports blood to the vital organs. Rather, it is a complex organ that remodels in dynamic fashion in response to biomechanical stresses that accumulate over the life course.1 The different segments of the aorta vary in their relations to risk factors, underscoring the heterogeneity in remodeling characteristics across the arterial tree.2 Second, age-associated changes in the aortic wall include fragmentation of the elastin fibers, increased synthesis of collagen, and calcification. The molecular epidemiology of these vascular remodeling changes have been well characterized, and are complex, being mediated via the interaction of vascular smooth muscle cells, integrins, metalloproteinases, endothelial function, and the renin-angiotensin axis, inflammation, and other pathways.1 Third, vascular flow propagation is the combination of steady flow (mean arterial pressure) and pulsatile (pulse pressure) components. The proximal (central) aorta stiffens with age, and these changes are associated with an increase in the pulsatile component (increased central pulse pressure), which in turn places a burden of increased afterload on the left ventricle. There is widespread agreement that elevated pulsatile load is associated with increased risk of cardiovascular disease, including myocardial infarction, stroke, and heart …

Nonpenetrating External Trabeculectomy for Congenital Glaucoma: A Retrospective Study

To evaluate the results of nonpenetrating external trabeculectomy (NPET) for primary congenital glaucoma (CG).Retrospective, noncomparative, interventional case series.Forty-three eyes of 27 consecutive patients with primary CG.Initial intent of NPET with intraoperative conversion to trabeculectomy in cases where aqueous humor outflow was deemed insufficient or where Schlemm's canal appeared to be absent.Intraocular pressure (IOP). Success was defined as an IOP less than 12.5 mmHg at 1 year after the procedure or later, using adjunctive pressure-lowering topical medications whenever needed.Mean initial measures of IOP were 18.8 mmHg. Of the 43 eyes, a total of 13 required conversion to trabeculectomy: 9 because of insufficient filtration, 3 because of an apparent absence of Schlemm's canal, and 1 because of accidental perforation. Of these 13 eyes that ultimately underwent trabeculectomy, 11 achieved successful IOP control, 3 in association with topical therapy. In 1 eye, a retinal detachment developed, and in 7 eyes, other complications were observed. Among the 30 remaining eyes that underwent NPET, 2 underwent the procedure twice, and 1 eye underwent the procedure 3 times. Postoperative complications were not noted in this NPET-only group. Mean postoperative IOP was 10.8 mmHg, with final IOP controlled in 28 of the 30 eyes (93%; P<0.0001), occasionally after repeat surgeries and in combination with topical therapy.Nonpenetrating external trabeculectomy may be considered as an initial procedure for some cases of primary CG. It appears to be an alternative to trabeculectomy with fewer risks of postoperative complications.

Acute angle-closure glaucoma due to iris transfixation of a subluxated posterior chamber intraocular lens–capsular bag complex

An 80-year-old woman with pseudoexfoliation syndrome developed subluxation of a posterior chamber intraocular lens (IOL)-capsular bag complex due to zonular rupture. She underwent a limited 25-gauge pars plana vitrectomy and iris transfixation of the subluxated IOL-capsule complex. The postoperative course was uneventful until the patient developed acute angle-closure glaucoma 3 weeks postoperatively. Ultrasound biomicroscopy confirmed pupillary block by the IOL-capsule complex. The patient was treated with intraocular pressure-lowering medications and a vitreous tap before a laser peripheral iridotomy could be performed successfully. The vision returned to normal, and the angle closure resolved. We recommend that a prophylactic surgical iridectomy be performed in patients with iris transfixation of a posterior chamber IOL-capsular bag complex.

Systemic Antihypertensive Medication and Incident Open-angle Glaucoma

To determine the association between systemic antihypertensive medication and incident open-angle glaucoma. Prospective population-based cohort study. The study population consisted of a subset of 3842 participants of the Rotterdam Study for whom data from identical ophthalmologic examinations at baseline and follow-up were available. Use of antihypertensive medication was registered over an average follow-up period of 6.5 years. Associations between incident open-angle glaucoma and antihypertensive medication were assessed using multivariate logistic regression models adjusted for age, gender, duration of follow-up, intraocular pressure, intraocular pressure-lowering medication, and cardiovascular disease. Odds ratios of associations between incident open-angle glaucoma and use of antihypertensive medication. During follow-up, there were 87 incident cases of open-angle glaucoma. Participants using calcium channel antagonists had a 1.8-fold (95% confidence interval [CI], 1.04-3.2; P = 0.037) higher risk of developing incident open-angle glaucoma. beta-Blockers were associated with a nonsignificant risk reduction (odds ratio, 0.6; 95% CI, 0.3-1.02; P = 0.060). None of the other classes of antihypertensives was significantly associated with incident open-angle glaucoma. These data suggest that use of calcium channel antagonists is associated with open-angle glaucoma, but this requires confirmation. These results do not support the use of calcium channel antagonists for the treatment of normal-tension glaucoma.

Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America

Background On the basis of the Framingham risk algorithm, overestimation of clinical events has been reported in some European populations. Electron-beam computed tomography-derived quantification of coronary artery calcification (CAC) allows for non-invasive assessment of coronary atherosclerosis in the general population and may thus add important in vivo information on the path from risk factor exposure to formation of clinical events. The current study was undertaken to compare the relationship between risk factors and subclinical coronary atherosclerosis between non-Hispanic white cohorts in Germany and US-America, the hypothesis being that subclinical coronary atherosclerosis might be less prevalent in Europe at the same level of classical risk factor exposure. Methods The Heinz Nixdorf Recall (HNR) study, conducted in the German Ruhr area and the Epidemiology of Coronary Calcification (ECAC) study, conducted in Olmsted County, Minnesota, both recruited large unselected cohorts, men and women aged 45–74 years, from the general population. All subjects with no history of coronary artery disease (CAD) or stroke were included ( n = 3120 in HNR, n = 703 in ECAC). Coronary risk factors were assessed by personal and computer-assisted interviews and direct laboratory measurements. Cardiovascular medication use (antihypertensive, lipid-lowering, and anti-diabetic) was noted. CAC scores were determined using the Agatston method in an identical fashion in both studies. Results Adverse levels of risk factors were more prevalent, and the Framingham risk score was higher (10.6 ± 7.6 versus 9.3 ± 7.1, p < 0.001) in HNR than ECAC, respectively. There was no difference in body mass index (BMI). CAC scores were greater in HNR than in ECAC (mean values, 155.7 ± 423.0 versus 107.2 ± 280.0; median values, 11.9 versus 2.4; p < 0.001, respectively). When subjects were matched on CAD risk factors, presence and quantity of CAC were similar in the 2 cohorts. Risk factors significantly associated with CAC score in both studies included: age, male sex, current and former smoking, systolic blood pressure, and non-HDL-cholesterol. Inferences were similar after excluding subjects using lipid- or blood pressure-lowering medications. Using the same risk factor variables for modelling, the predicted CAC scores were comparable in both cohorts. Conclusions In the higher-risk German cohort, presence and quantity of CAC were greater than in the lower-risk US-American cohort. Risk factor associations with CAC were very similar in both unselected populations. We could not demonstrate a relative increase in subclinical coronary atherosclerosis in the US-American cohort. It appears possible to compare CAC as a measure of subclinical coronary artery disease in different populations on different continents, and accordingly, scanning guidelines might be translated across these populations.

Efficacy and safety of intravenous injection of lidocaine in the treatment of acute primary angle-closure glaucoma: a pilot study

To study the safety and effectiveness of a combination of both intravenous injection of lidocaine and intraocular pressure-lowering medications, in the intraocular pressure control and relief of symptoms of refractory acute primary angle-closure glaucoma (PACG). Five consecutive patients with their first attack of acute PACG, with intraocular pressure > or = 45 mmHg and a failure to release from the attack under antiglaucomatous medications for 4 hours, were recruited into the study. On presentation, each patient received topical pilocarpine and timolol, and systemic acetazolamide and mannitol as primary treatment. Then the patients accepted 2% lidocaine by intravenous injection at dose of 0.8 mg/kg in concert with antiglaucomatous medications. The intraocular pressures after intravenous injection at 30 minutes, and then at 1, 2, 4, 12, and 24 hours, were documented by applanation tonometry. Symptoms, visual acuity, intraocular pressure, corneal edema, angle status on gonioscopy, pupillary size, and reaction were also measured. Six eyes of five patients seen with acute PACG were recruited. The mean intraocular pressure was reduced from 50.83 +/- 5.34 mmHg to 39.5 +/- 3.45 mmHg at 30 minutes after intravenous injection, and then to 33.3 +/- 3.56 mmHg at 1 hour, and 24.55 +/- 5.09 mmHg at 2 hours after intravenous injection. The mean intraocular pressure was less than 21 mmHg at 4 hours and beyond. There was instant symptomatic relief for all patients. No complications were encountered. From this preliminary study, intravenous injection of lidocaine seems to be safe and effective in controlling intraocular pressure and eliminating symptoms in acute PACG. But the exact efficacy and safety need further investigation in large case studies.

Rates and determinants of reinitiating antihypertensive therapy after prolonged stoppage: a population-based study

To assess patterns of restarting antihypertensive drugs after a prolonged period of discontinuation. We conducted a retrospective cohort study among new users of blood pressure-lowering medication in the PHARMO database in The Netherlands, who had a period of at least 180 days without such medication. A multivariable Cox proportional hazard analysis was used to explore the baseline variables associated with reinitiating treatment. Case-crossover analysis was used to evaluate determinants of reinitiating treatment. We identified 35,714 patients as initiating blood pressure-lowering treatment during the period 1 January 1999 to 30 June 2004. Of the 18,357 (51.4%) patients who discontinued blood pressure-lowering treatment, 19.3% restarted treatment within 1 year and 60.7% restarted within 6 years. With every additional year they had been on therapy, patients were more likely to restart [odds ratio (OR) = 1.38; 95% confidence interval (CI) = 1.34-1.42]. The case-crossover analysis revealed that hospitalization for cardiovascular disease (OR = 2.20; 95% CI = 1.84-2.63), as well as refilling of another cardiovascular medication (OR = 1.25; 95% CI = 1.11-1.40), were each independently associated with reinitiating treatment. Refilling non-cardiovascular medications was not associated with reinitiating treatment (OR = 1.03; 95% CI = 0.97-1.10). Physicians should be aware that many patients have prolonged periods of discontinuation during the use of blood pressure-lowering medication, and that most of these patients will eventually resume therapy. Ongoing refilling other medications is not associated with reinitiating treatment. This suggests that, for some patients, the decision to discontinue may be drug specific rather than a behavioural characteristic applicable to all chronic treatments.

Electronic pillboxes (MEMS) to assess the relationship between medication adherence and blood pressure control in primary care

Objective. To investigate the relationship between blood pressure and medication adherence using electronic pillboxes (MEMS). Setting. Five general practices in Bristol, UK. Subjects. A total of 239 individuals with a clinical diagnosis of hypertension and being prescribed at least one blood pressure-lowering medication. Participants were asked to use the electronic pillbox as their drug bottle for at least one month. Main outcome measures. “Timing adherence” (correct inter-dose intervals) as measured through MEMS and systolic (SBP) and diastolic (DBP) office blood pressure. Results. Mean (±SD) timing adherence was 88% (±17),>80% in 175 (73%), and less than 50% in 11 (5%) participants. Adherence was monitored for a mean of 33 (±6) days. Mean (±SD) SBP was 147.9±19.1 mmHg and DBP 82.3±10.1 mmHg. There was no evidence to suggest that timing adherence was associated with SBP or DBP (overall correlation coefficients −0.01 and −0.02 respectively). According to current guidelines, about one in four of all participants had controlled SBP (only 6% of diabetic patients). DBP was under control in 66% of the individuals. Conclusions. No relationship between adherence and blood pressure in patients with hypertension recruited from primary care was found. Average timing adherence measured by electronic monitors was high (88%) and blood pressure was controlled in a minority of patients. Our findings suggest that in terms of poor blood pressure control pharmacological non-response to or insufficient intensity of blood pressure-lowering medication might be more important than poor adherence to antihypertensive drug therapy.

Assessment of blood pressure control in hypertensive stroke survivors: an ambulatory blood pressure monitoring study

We compared the sensitivity of office blood pressure and ambulatory blood pressure monitoring recordings in evaluating the effectiveness of antihypertensive treatment and identified factors related to inadequate blood pressure control among hypertensive stroke survivors. Office blood pressure and ambulatory blood pressure monitoring measurements were performed at 120+/-30 days after ictus in 187 first-ever consecutive hypertensive stroke survivors who were receiving blood pressure-lowering medications according to international guidelines. Handicap was assessed by the modified Rankin Scale. Blood pressure was regarded as controlled if office and daytime ambulatory systolic and diastolic blood pressure values were <140/90 and <135/85 mmHg, respectively. Patients were subclassified according to the degree of their nocturnal systolic blood pressure fall [(mean daytime values-mean night-time values)100/mean daytime values] as dippers (>or=10%), nondippers (>or=0% and <10%) and reverse dippers (<0%). Effective blood pressure control was documented in significantly (P<0.001) fewer patients using ambulatory blood pressure monitoring (32.1%) than those using office recordings (43.3%), whereas in 16% of the study population a masked lack of per-treatment blood pressure control (elevated ambulatory blood pressure in the presence of normal office blood pressure levels) was identified. The distribution of dipping patterns differed significantly (P=0.01) between controlled hypertensive individuals (normal office and ambulatory measurements) and patients with isolated ambulatory hypertension (dippers: 31.3 vs. 10.0%; nondippers:56.9 vs. 53.3%; reverse dippers: 11.8 vs. 36.7%). Logistic regression analysis revealed diabetes mellitus and functional independency (modified Rankin Scale score<2) as independent predictors of inadequate blood pressure control. Ambulatory blood pressure monitoring detects a substantial number of treated hypertensive stroke survivors with a masked lack of per-treatment blood pressure control, who present a higher prevalence of abnormal circadian blood pressure patterns (reverse dipping). Diabetes mellitus and poststroke functional independency are the main factors contributing to inadequate blood pressure control.

Carotid Artery Disease

Carotid arteries are the blood vessels that deliver blood through the neck to the brain. There is one carotid artery on each side of the neck, where its pulsation can be felt with a finger below the jaw bone. Blockages in the carotid artery decrease blood flow to the brain, causing a medical condition known as carotid artery disease. Interruptions in blood flow to the brain (commonly known as stroke) can cause permanent injury. This Cardiology Patient Page describes how blockages resulting from carotid artery disease cause stroke and what you and your doctor can do to prevent it. Stroke, or cerebrovascular accident, is most frequently caused by a sudden stoppage of blood flow to a portion of the brain. Every year in the United States, an estimated 750 000 people become victims of stroke. There are 2 common causes of stroke. First, an irregular heart rhythm, called atrial fibrillation, can cause stroke when small blood clots form as the heart is quivering instead of beating normally. Once a small blood clot is formed, it can be launched by the heart through the carotid arteries, block a blood vessel in the brain, and deprive that part of the brain of blood, resulting in a stroke. The other common cause of stroke is a blockage in the carotid arteries. The carotid arteries carry blood to the brain; like the blood vessels that supply blood to the heart, these arteries can become narrowed or blocked. The blockages are deposits of cholesterol, or atherosclerosis, that narrow the blood flow channel in the carotid arteries (Figure 1). If these cholesterol deposits or blockages break or rupture, small blood clots and cholesterol fragments break off from the plaque, enter the blood flow to the brain, and can get caught in a smaller blood vessel in …

Sex-specific cardiovascular morbidity and mortality in a cohort treated for hypertension

Incidence of cardiovascular disease (CVD) is higher in men than in women. The aim of this study was to investigate whether the gender differential can be modified by pharmacological intervention in a population-based setting. In a prospective population-based cohort--the Malmö Diet and Cancer study--a total of 3608 hypertensives (1559 men, 2049 women), 45-73 years old, with a mean of 10 years' treatment at baseline examination, participated in the study. Information on blood pressure-lowering medication was collected in a questionnaire. Incidences of first-ever cardiac event, stroke or CVD death were followed. The mean period of follow-up was 7.4 years. During follow-up, 341 first-ever CVD events and 128 CVD deaths occurred. The risk of CVD morbidity or mortality was significantly higher in hypertensive men than in hypertensive women: cardiac event [relative risk (RR) = 3.11; 95% confidence interval (CI): 2.13-4.54], stroke (RR = 1.50; 95% CI: 1.01-2.22) and CVD death (RR = 2.96; 95% CI: 1.86-4.20). However, the gender gap in CVD risks was reduced with advancing age. Two background factors--single household and concomitant diabetes--are apt to have an independent sex-specific impact on CVD risk. Gender remains a strong independent predictor for CVD morbidity and mortality, irrespective of antihypertensive intervention or other risk factors. Increased clinical attention should be given to hypertensive men living alone and hypertensive women with diabetes.

Exercise frequency and arterial compliance in non-diabetic and type 1 diabetic individuals

The role of exercise in preventing cardiovascular disease (CVD) has been well documented. To determine whether this benefit could be related to effects on vascular endothelial function and vessel wall elasticity, thereby preserving arterial compliance, we examined the relationship between habitual exercise and arterial compliance as measured by pulse wave analysis. A cross-sectional study of healthy volunteers and patients with type 1 diabetes. Non-diabetic individuals not taking cholesterol or blood pressure-lowering medication (n=176) and patients with type 1 diabetes (n=105), aged 17-70 years, were recruited. Small and large artery compliance and other haemodynamic variables were measured using the PulseWave CR-2000 cardiovascular profiling system. A questionnaire was completed to assess the frequency of physical activity. In multivariate analysis, undertaking three or more episodes of vigorous activity per week was associated with having a 1 unit greater small artery compliance, independent of age, sex, height, diabetes status and blood pressure. The effect was especially marked in non-diabetic women. The results support other findings that regular physical activity protects against CVD, through the preservation of vascular compliance.

Pars plana insertion of glaucoma drainage devices for refractory glaucoma

Glaucoma drainage devices are more commonly inserted into the anterior chamber because of the relative ease of this method of insertion. However, in certain cases, posterior placement of the tube may be necessary or may be more desirable. The outcome of a series of patients with glaucoma drainage devices inserted into the pars plana was examined. Retrospective chart review of patients who underwent pars plana implantation of Molteno and Baerveldt glaucoma drainage devices at the Sydney Eye Hospital. There were 33 cases reviewed. The mean follow-up period was 30.2 months. The mean final postoperative intraocular pressure was reduced to 13.4 +/- 4.4 mmHg (SD) from 33.06 +/- 8.47 mmHg preoperatively. The mean number of intraocular pressure-lowering medications in use postoperatively was 0.6 +/- 0.8, reduced from 3.6 +/- 1.27 medications in use preoperatively. Sixteen (48.5%) eyes were classified as complete successes, 14 (42.4%) eyes as qualified successes and three eyes (9%) as failures. Kaplan-Meier survival analysis for cumulative success (absence of failure) predicted 61.1% survival at 60 months. Complications included five cases of decompensation of corneas or corneal grafts, one case each of conjunctival wound dehiscence, large choroidal effusion, epiretinal membrane, Molteno plate extrusion and intraocular pressure unresponsive to medical therapy, and three cases of tube blockage. In this series of patients, pars plana insertion of glaucoma drainage devices has been shown to be an effective alternative for selected cases where anterior chamber tube insertion is not possible or is not ideal.

A Markov modelled pharmacoeconomic analysis of bimatoprost 0.03% in the treatment of glaucoma as an alternative to filtration surgery in Italy

ABSTRACTObjective: Glaucoma is generally managed by decreasing the intraocular pressure (IOP) to a level believed to prevent further damage to the optic disc and loss of visual field. This may be achieved medically or surgically. The objective of this pharmacoeconomic analysis was to investigate the 4‐year costs of bimatoprost 0.03% (Lumigan) eye drops as an alternative to filtration surgery (FS) for glaucoma patients on maximum tolerable medical therapy (MTMT).† Lumigan is a registered trade name of Allergan, Inc., USAResearch design and method: A Markov model was designed using effectiveness and resource use data from a randomized clinical trial and expert statements (Delphi panel). The RCT covered 83 patients on MTMT. The model compared bimatoprost with FS. In the bimatoprost model arm patients began treatment with bimatoprost. If target IOP (–20%) was not reached using medical therapy the patient proceeded with FS. In the FS model arm, FS was performed after the first ophthalmologist visit. Unit costs were obtained from an Italian chart and tariffs review (healthcare sector perspective).Results: The RCT showed that 74.7% of the patients delayed the need for FS by 3 months. The Markov model forecasted that 64.2% of the patients could delay the need for FS by 1 year, and forecasted 34.0% could avoid FS after 4 years. The 4‐year cost per patient in the bimatoprost and FS arms was €3438 and €4194, respectively (incremental costs of €755). The major cost drivers for the bimatoprost arm were patients who needed combination therapy or FS if the target IOP was not reached. In the FS arm, the major cost drivers were the initial surgery costs and pressure-lowering medications used as add-on therapy after FS.Conclusions: The analysis shows that in a 4‐year perspective bimatoprost is cheaper compared to FS. In addition, the postponement of FS associated with bimatoprost may have important implications for waiting list planning.

Compliance to medication among hypertensive patients in Murtala Mohammed Specialist Hospital, Kano, Nigeria

Background: Non-compliance to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. We assessed the level of compliance to anti-hypertensive therapy and identified factors contributing to poor compliance among hypertensives in Kano. Methodology: Three hundred and sixty outpatients were interviewed using a pre-tested, structured, mostly closed ended questionnaire in Murtala Mohammed Specialist Hospital in Kano, Nigeria. Results: Good compliance with drug treatment was observed in 54.2% of the respondents and poor compliance among the remainder. Poor compliance was found to be mainly due to ignorance on need for regular treatment (32.7%), lack of funds to purchase drugs (32.7%) and side effects of drugs (12.1%). Patients with formal education, and higher monthly income were more compliant to treatment. In addition, those on single drugs were more compliant compared to those on two or more drugs. Poor compliance was found to be mainly due to ignorance and lack of funds to purchase drugs. Conclusion: Based on the findings of this study, there is a need for launching a comprehensive approach involving health care providers, patients and the general public to educating patients on the need to take their drugs regularly and in the manner prescribed. Doctors should consider the financial status of their patients in prescribing antihypertensive drugs to enable affordability. Prices of anti-hypertensive drugs should be subsidized where possible. Prescribing an effective, inexpensive, single dose daily medication with minimal side effects will improve patient compliance considerably. Key Words: Hypertension; Medication; Compliance; Kano Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 16-20